Four ways to prevent caries in high-risk patients while increasing practice production

Patients with a high risk of caries need a robust fortification and remineralization program. As a mobile provider, I realized very quickly that fluoride varnish alone was not enough for high-risk patients, so I began applying minimally invasive principles into my mobile practice. I was first introduced to these concepts through the CareQuest Institute’s Minimally Invasive Dental Caries Guide¹, which emphasizes early intervention, disease management, and prevention over surgical repair.

These strategies not only help prevent new carious lesions and arrest disease earlier, but allow practices to deliver more effective care while increasing clinical efficiency and office production for things that patients need. 

The importance of early identification 

Early identification of demineralized enamel is essential when managing patients at high risk of caries. By making early disease visible to both clinicians and patients, technology can support earlier intervention, improve patient understanding and case acceptance, and help drive increased preventive and restorative production within the practice.

BlueCheck is a paint-on diagnostic agent composed of a protein with high affinity for hydroxyapatite, allowing clinicians to visualize areas of active demineralization. LumiCare uses a cavity detection rinse with biocompatible fluorescent agents that bind to porous enamel, highlighting early lesions that may not yet be clinically apparent. 

Fortification 

Once demineralization is identified, the next step is fortifying these early lesions through remineralization therapies such as silver diamine fluoride 38% (SDF) or P11-4 peptide technology. SDF is highly effective for arresting and preventing caries, though it does stain areas of demineralization, making it ideal for nonesthetic zones.

In contrast, self-assembling P11-4 peptides provide a cosmetic friendly option for esthetic areas by infiltrating early enamel lesions and forming a three-dimensional scaffold that attracts calcium and phosphate ions, supporting guided enamel remineralization without staining. Both approaches align with minimally invasive caries management principles by arresting disease prior to cavitation and creating billable preventive services that improve patient outcomes while increasing practice production.  

Preventing disease progression 

Once demineralized areas have been fortified, ongoing protection is essential to prevent disease progression, and this is where preventive sealants and placing SDF preventively plays a critical role.

Glass ionomer sealants are particularly well suited for high-risk patients of all ages, due to their fluoride release, chemical bonding, and tolerance for slightly moist conditions. Preventive application of SDF has also been shown to prevent caries incidence by approximately 70% when applied to sound tooth structures demonstrating effectiveness comparable to sealants in high risk populations.² Note that when SDF is applied to sound tooth structure, it doesn’t stain. Sealants and SDF provide evidence-based, non-invasive preventive services that support long term disease control while increasing office production. 

Povidone‑iodine (10%) is a powerful tool for caries prevention that works by reducing levels of Streptococcus mutans and other pathogenic bacteria in the oral biofilm. When applied prior to fluoride varnish, it creates a synergistic effect as it prepares the surface for effective remineralization of enamel. This combination has been shown to reduce new carious lesions in high‑risk populations. 

By identifying lesions early, fortifying enamel, and maintaining ongoing protection, clinicians can arrest disease before cavitation, enhance patient outcomes, and increase clinical efficiency and production. Watch povidone iodine 10% inaction on YouTube.  

References 

1. Minimally invasive caries management: a practical guide for dental teams. CareQuest Institute for Oral Health. 

2. Ruff RR, Barry‑Godín, T, Niederman R. Effect of silver diamine fluoride on caries arrest and prevention: The CariedAway school‑based randomized clinical trial. JAMA Netw Open. 20231;6(2):e2255458. doi:10.1001/jamanetworkopen.2022.55458